88 research outputs found
Applying human factors methods to explore âWork as Imaginedâ and âWork as Doneâ in the Emergency Departmentâs response to chemical, biological, radiological, and nuclear events
The Emergency Department (ED) is a complex, hectic, and high-pressured environment.
Chemical, Biological, Radiological, and Nuclear (CBRN) events are multi-faceted emergencies and present numerous challenges to ED staff (first receivers) with large scale trauma, consequently requiring a combination of complex responses.
Human Factors and Ergonomics (HF/E) methods such as Hierarchical Task Analysis (HTA) have been used in healthcare research. However, HF/E methods and theory have not been combined to understand how the ED responds to CBRN events.
This study aimed to compare Work as Imagined (WAI) and Work as Done (WAD) in the ED CBRN response in a UK based hospital. WAI was established by carrying out document analyses on a CBRN plan and WAD by exploring
first receivers response to CBRN scenario cards. The responses were converted to HTAs and compared. The WAI HTAs showed 4-8 phases of general organizational responsibilities
during a CBRN event. WAD HTAs placed emphasis on diagnosing and treating
presenting conditions. A comparison of WAI and WAD HTAs highlighted common actions and tasks. This study has identified three key differences between WAI and WAD in the ED CBRN response: 1) documentation of the
CBRN event 2) treating the patient and 3) diagnosing the presenting complaint.
Findings from this study provide an evidence base which can be used to inform future clinical policy and practice in providing safe and high quality care during CBRN events in the ED
Updated framework on quality and safety in emergency medicine
Objectives Quality and safety of emergency care is critical. Patients rely on emergency medicine (EM) for accessible, timely and high-quality care in addition to providing a âsafety-netâ function. Demand is increasing, creating resource challenges in all settings. Where EM is well established, this is recognised through the implementation of quality standards and staff training for patient safety. In settings where EM is developing, immense system and patient pressures exist, thereby necessitating the availability of tiered standards appropriate to the local context.Methods The original quality framework arose from expert consensus at the International Federation of Emergency Medicine (IFEM) Symposium for Quality and Safety in Emergency Care (UK, 2011). The IFEM Quality and Safety Special Interest Group members have subsequently refined it to achieve a consensus in 2018.Results Patients should expect EDs to provide effective acute care. To do this, trained emergency personnel should make patient-centred, timely and expert decisions to provide care, supported by systems, processes, diagnostics, appropriate equipment and facilities. Enablers to high-quality care include appropriate staff, access to care (including financial), coordinated emergency care through the whole patient journey and monitoring of outcomes. Crowding directly impacts on patient quality of care, morbidity and mortality. Quality indicators should be pragmatic, measurable and prioritised as components of an improvement strategy which should be developed, tailored and implemented in each setting.Conclusion EDs globally have a remit to deliver the best care possible. IFEM has defined and updated an international consensus framework for quality and safety
Does dietary fat affect inflammatory markers in overweight and obese individuals?âa review of randomized controlled trials from 2010 to 2016
Hidden dynamics of soccer leagues: the predictive âpowerâ of partial standings
Objectives Soccer leagues reflect the partial standings of the teams involved after each round of competition. However, the ability of partial league standings to predict end-of-season position has largely been ignored. Here we analyze historical partial standings from English soccer to understand the mathematics underpinning league performance and evaluate the predictive âpowerâ of partial standings. Methods Match data (1995-2017) from the four senior English leagues was analyzed, together with random match scores generated for hypothetical leagues of equivalent size. For each season the partial standings were computed and Kendallâs normalized tau-distance and Spearman r-values determined. Best-fit power-law and logarithmic functions were applied to the respective tau-distance and Spearman curves, with the âgoodness-of-fitâ assessed using the R2 value. The predictive ability of the partial standings was evaluated by computing the transition probabilities between the standings at rounds 10, 20 and 30 and the final end-of-season standings for the 22 seasons. The impact of reordering match fixtures was also evaluated. Results All four English leagues behaved similarly, irrespective of the teams involved, with the tau-distance conforming closely to a power law (R2>0.80) and the Spearman r-value obeying a logarithmic function (R2>0.87). The randomized leagues also conformed to a power-law, but had a different shape. In the English leagues, team position relative to end-of-season standing became âfixedâ much earlier in the season than was the case with the randomized leagues. In the Premier League, 76.9% of the variance in the final standings was explained by round-10, 87.0% by round-20, and 93.9% by round-30. Reordering of match fixtures appeared to alter the shape of the tau-distance curves. Conclusions All soccer leagues appear to conform to mathematical laws, which constrain the league standings as the season progresses. This means that partial standings can be used to predict end-of-season league position with reasonable accuracy
Suppression of MAPK attenuates neuronal cell death induced by activated glia-conditioned medium in alpha-synuclein overexpressing SH-SY5Y cells
A global experiment on motivating social distancing during the COVID-19 pandemic
Significance
Communicating in ways that motivate engagement in social distancing remains a critical global public health priority during the COVID-19 pandemic. This study tested motivational qualities of messages about social distancing (those that promoted choice and agency vs. those that were forceful and shaming) in 25,718 people in 89 countries. The autonomy-supportive message decreased feelings of defying social distancing recommendations relative to the controlling message, and the controlling message increased controlled motivation, a less effective form of motivation, relative to no message. Message type did not impact intentions to socially distance, but peopleâs existing motivations were related to intentions. Findings were generalizable across a geographically diverse sample and may inform public health communication strategies in this and future global health emergencies.
Abstract
Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on oneâs core values) or behavioral intentions. Results supported hypothesized associations between peopleâs existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges
A(c)(+) Production and Baryon-to-Meson Ratios in pp and p-Pb Collisions at root S-NN=5.02 TeV at the LHC
The prompt production of the charm baryon \u39bc+ and the \u39bc+/D0 production ratios were measured at midrapidity with the ALICE detector in pp and p-Pb collisions at sNN=5.02 TeV. These new measurements show a clear decrease of the \u39bc+/D0 ratio with increasing transverse momentum (pT) in both collision systems in the range 2<12 GeV/c, exhibiting similarities with the light-flavor baryon-to-meson ratios p/\u3c0 and \u39b/KS0. At low pT, predictions that include additional color-reconnection mechanisms beyond the leading-color approximation, assume the existence of additional higher-mass charm-baryon states, or include hadronization via coalescence can describe the data, while predictions driven by charm-quark fragmentation processes measured in e+e- and e-p collisions significantly underestimate the data. The results presented in this Letter provide significant evidence that the established assumption of universality (colliding-system independence) of parton-to-hadron fragmentation is not sufficient to describe charm-baryon production in hadronic collisions at LHC energies
A(c)(+) Production and Baryon-to-Meson Ratios in pp and p-Pb Collisions at root S-NN=5.02 TeV at the LHC
The prompt production of the charm baryon Î_{c}^{+} and the Î_{c}^{+}/D^{0} production ratios were measured at midrapidity with the ALICE detector in pp and p-Pb collisions at sqrt[s_{NN}]=5.02ââTeV. These new measurements show a clear decrease of the Î_{c}^{+}/D^{0} ratio with increasing transverse momentum (p_{T}) in both collision systems in the range 2<p_{T}<12ââGeV/c, exhibiting similarities with the light-flavor baryon-to-meson ratios p/Ï and Î/K_{S}^{0}. At low p_{T}, predictions that include additional color-reconnection mechanisms beyond the leading-color approximation, assume the existence of additional higher-mass charm-baryon states, or include hadronization via coalescence can describe the data, while predictions driven by charm-quark fragmentation processes measured in e^{+}e^{-} and e^{-}p collisions significantly underestimate the data. The results presented in this Letter provide significant evidence that the established assumption of universality (colliding-system independence) of parton-to-hadron fragmentation is not sufficient to describe charm-baryon production in hadronic collisions at LHC energies
Suppression in Pb-Pb Collisions at the LHC.
The production of the Ï(2S) charmonium state was measured with ALICE in Pb-Pb collisions at sqrt[s_{NN}]=5.02ââTeV, in the dimuon decay channel. A significant signal was observed for the first time at LHC energies down to zero transverse momentum, at forward rapidity (2.5<y<4). The measurement of the ratio of the inclusive production cross sections of the Ï(2S) and J/Ï resonances is reported as a function of the centrality of the collisions and of transverse momentum, in the region p_{T}<12ââGeV/c. The results are compared with the corresponding measurements in pp collisions, by forming the double ratio [Ï^{Ï(2S)}/Ï^{J/Ï}]_{Pb-Pb}/[Ï^{Ï(2S)}/Ï^{J/Ï}]_{pp}. It is found that in Pb-Pb collisions the Ï(2S) is suppressed by a factor of âŒ2 with respect to the J/Ï. The Ï(2S) nuclear modification factor R_{AA} was also obtained as a function of both centrality and p_{T}. The results show that the Ï(2S) resonance yield is strongly suppressed in Pb-Pb collisions, by a factor of up to âŒ3 with respect to pp. Comparisons of cross section ratios with previous Super Proton Synchrotron findings by the NA50 experiment and of R_{AA} with higher-p_{T} results at LHC energy are also reported. These results and the corresponding comparisons with calculations of transport and statistical models address questions on the presence and properties of charmonium states in the quark-gluon plasma formed in nuclear collisions at the LHC
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